I certify that I am the authorized holder and signer of the
credit card referenced above. I certify that all the
information above is complete and accurate.
I understand that the information input is correct to my
knowledge. Submitting false information could result in
penalties and fines. It is a federal crime to submit false
information in an attempt to commit fraud.
I hereby authorize the collection of payment to DOT
Operating Authority Inc., (DBA) New Mexico Weight Distance
Permit, for all charges as indicated above. I acknowledge
that charges to my provided payment method may not exceed
the total amount listed under the “TOTAL COST” field. I
understand that I am responsible for the full amount listed
in the “TOTAL COST” field. I understand that this
authorization is only in effect during the time period of
this transaction. If any additional charges are to need
authorization, a new authorization form will have to be
completed.
I acknowledge that the total amount of today’s transaction,
indicated under the “TOTAL COST” field includes any and all
Federal, State, and Local Government fees.
I hereby acknowledge and agree that after the charges are
authorized, a DOT Operating Authority Inc., (DBA) New Mexico
Weight Distance Permit agent will be assigned within 15
minutes to complete the order. Once the agent has been
assigned, the payment cannot be cancelled, and the charges
are non-refundable. DOT Operating Authority Inc., (DBA) New
Mexico Weight Distance Permit does not accept any
responsibility for refusal or reversal of payments, which
shall be a matter between you and your credit card issuer.